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Cardiac resynchronization therapy using a dual chamber pacemaker in patients with severe left ventricular dysfunction and a left bundle branch block.

Jung JJ, Kim IS, Jeong JH, Lee YT, Jeong DS - Korean J Thorac Cardiovasc Surg (2013)

Bottom Line: Through the use of a dual chamber (DDD) pacemaker, we achieved a cardiac resynchronization effect in a 51-year-old female patient who was transferred to our hospital from another hospital for an operation for three-vessel coronary artery disease.The biventricular synchronization using DDD pacing was turned off 18 hours after surgery.She was transferred to a general ward with a cardiac output of 3.9 L/min.

View Article: PubMed Central - PubMed

Affiliation: Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea.

ABSTRACT
Through the use of a dual chamber (DDD) pacemaker, we achieved a cardiac resynchronization effect in a 51-year-old female patient who was transferred to our hospital from another hospital for an operation for three-vessel coronary artery disease. Her electrocardiogram showed a left bundle branch block (LBBB) and a prolonged QRS interval of 166 milliseconds. Severe left ventricle (LV) dysfunction was diagnosed via echocardiography. Coronary artery bypass grafting (CABG) was then performed. In order to accelerate left atrial activation and reduce the conduction defect, DDD pacing using right atrial and left and right ventricular pacing wires was initiated postoperatively. The cardiac output was measured immediately, and one and twelve hours after arrival in the intensive care unit. The cardiac output changed from 2.8, 2.4, and 3.6 L/min without pacing to 3.5, 3.4, and 3.5 L/min on initiation of pacing. The biventricular synchronization using DDD pacing was turned off 18 hours after surgery. She was transferred to a general ward with a cardiac output of 3.9 L/min. In patients with coronary artery disease, severe LV dysfunction, and LBBB, cardiac resynchronization therapy can be achieved through DDD pacing after CABG.

No MeSH data available.


Related in: MedlinePlus

The pacemaker used in this case (Medtronic 5388 Dual Chamber Temporary Pacemaker; Medtronic Inc.).
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Figure 1: The pacemaker used in this case (Medtronic 5388 Dual Chamber Temporary Pacemaker; Medtronic Inc.).

Mentions: She had a diagnosis of hypertension and a history of an intraventricular block eight years earlier that was treated with digoxin, diuretics, beta-blockers, and an angiotensin-receptor blocker. Cardiomegaly was found on a posteroanterior chest radiograph, and a left bundle branch block (LBBB) pattern and prolonged QRS interval were identified on an electrocardiogram (ECG). Echocardiography also demonstrated left ventricle (LV) distension, severe LV dysfunction with a left ventricular ejection fraction (LVEF) of 28%, and mild mitral regurgitation. Pro-B-type natriuretic peptide was 2,070 pg/mL, and cardiac markers were normal. On-pump CABG was performed on day two of hospitalization. The left anterior descending coronary artery and diagonal branch were connected to the left internal mammary artery in situ, and a saphenous vein graft was used to connect the posterior descending artery and posterolateral artery. The patient had LV incompetence. Cardiac resynchronization therapy was attempted. Two temporary, unipolar, atrial pacing wires were inserted in the right atrium wall, and two temporary, bipolar, ventricular pacing wires were inserted into the right ventricular anterior wall and the left ventricular inferior wall. Temporary pacemakers (Medtronic 5388 Dual Chamber Temporary Pacemaker; Medtronic Inc., Minneapolis, MN, USA) were used since cardiac resynchronization therapy equipment was unavailable (Fig. 1). The rate was set to 66 ppm, and the sensitivities were set to 0.4 mV for the atria and 2.0 mV for the ventricles. The output was set to 10 mA for the atria and 20 mA for the ventricles. Wires inserted in the right atrium and left ventricular inferior wall were used, and a 196-millisecond PR interval verified from a preoperative ECG was used as a standard. QRS intervals were observed via ECG, and the PR interval was manipulated. The narrowest QRS was found using the PR interval standard, and the setting was changed (Fig. 2). Before cardiac resynchronization therapy (CRT) was initiated, intraoperative transesophageal echocardiography showed that the LVEF measured below 25%. On initiation of CRT, the LVEF increased visibly to about 40%. The cardiac output was measured immediately, and one hour and twelve hours after arrival in the intensive care unit. The cardiac output changed from 2.8, 2.4, and 3.6 L/min without pacing to 3.5, 3.4, and 3.5 L/min on initiation of pacing (Table 1).


Cardiac resynchronization therapy using a dual chamber pacemaker in patients with severe left ventricular dysfunction and a left bundle branch block.

Jung JJ, Kim IS, Jeong JH, Lee YT, Jeong DS - Korean J Thorac Cardiovasc Surg (2013)

The pacemaker used in this case (Medtronic 5388 Dual Chamber Temporary Pacemaker; Medtronic Inc.).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3756161&req=5

Figure 1: The pacemaker used in this case (Medtronic 5388 Dual Chamber Temporary Pacemaker; Medtronic Inc.).
Mentions: She had a diagnosis of hypertension and a history of an intraventricular block eight years earlier that was treated with digoxin, diuretics, beta-blockers, and an angiotensin-receptor blocker. Cardiomegaly was found on a posteroanterior chest radiograph, and a left bundle branch block (LBBB) pattern and prolonged QRS interval were identified on an electrocardiogram (ECG). Echocardiography also demonstrated left ventricle (LV) distension, severe LV dysfunction with a left ventricular ejection fraction (LVEF) of 28%, and mild mitral regurgitation. Pro-B-type natriuretic peptide was 2,070 pg/mL, and cardiac markers were normal. On-pump CABG was performed on day two of hospitalization. The left anterior descending coronary artery and diagonal branch were connected to the left internal mammary artery in situ, and a saphenous vein graft was used to connect the posterior descending artery and posterolateral artery. The patient had LV incompetence. Cardiac resynchronization therapy was attempted. Two temporary, unipolar, atrial pacing wires were inserted in the right atrium wall, and two temporary, bipolar, ventricular pacing wires were inserted into the right ventricular anterior wall and the left ventricular inferior wall. Temporary pacemakers (Medtronic 5388 Dual Chamber Temporary Pacemaker; Medtronic Inc., Minneapolis, MN, USA) were used since cardiac resynchronization therapy equipment was unavailable (Fig. 1). The rate was set to 66 ppm, and the sensitivities were set to 0.4 mV for the atria and 2.0 mV for the ventricles. The output was set to 10 mA for the atria and 20 mA for the ventricles. Wires inserted in the right atrium and left ventricular inferior wall were used, and a 196-millisecond PR interval verified from a preoperative ECG was used as a standard. QRS intervals were observed via ECG, and the PR interval was manipulated. The narrowest QRS was found using the PR interval standard, and the setting was changed (Fig. 2). Before cardiac resynchronization therapy (CRT) was initiated, intraoperative transesophageal echocardiography showed that the LVEF measured below 25%. On initiation of CRT, the LVEF increased visibly to about 40%. The cardiac output was measured immediately, and one hour and twelve hours after arrival in the intensive care unit. The cardiac output changed from 2.8, 2.4, and 3.6 L/min without pacing to 3.5, 3.4, and 3.5 L/min on initiation of pacing (Table 1).

Bottom Line: Through the use of a dual chamber (DDD) pacemaker, we achieved a cardiac resynchronization effect in a 51-year-old female patient who was transferred to our hospital from another hospital for an operation for three-vessel coronary artery disease.The biventricular synchronization using DDD pacing was turned off 18 hours after surgery.She was transferred to a general ward with a cardiac output of 3.9 L/min.

View Article: PubMed Central - PubMed

Affiliation: Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea.

ABSTRACT
Through the use of a dual chamber (DDD) pacemaker, we achieved a cardiac resynchronization effect in a 51-year-old female patient who was transferred to our hospital from another hospital for an operation for three-vessel coronary artery disease. Her electrocardiogram showed a left bundle branch block (LBBB) and a prolonged QRS interval of 166 milliseconds. Severe left ventricle (LV) dysfunction was diagnosed via echocardiography. Coronary artery bypass grafting (CABG) was then performed. In order to accelerate left atrial activation and reduce the conduction defect, DDD pacing using right atrial and left and right ventricular pacing wires was initiated postoperatively. The cardiac output was measured immediately, and one and twelve hours after arrival in the intensive care unit. The cardiac output changed from 2.8, 2.4, and 3.6 L/min without pacing to 3.5, 3.4, and 3.5 L/min on initiation of pacing. The biventricular synchronization using DDD pacing was turned off 18 hours after surgery. She was transferred to a general ward with a cardiac output of 3.9 L/min. In patients with coronary artery disease, severe LV dysfunction, and LBBB, cardiac resynchronization therapy can be achieved through DDD pacing after CABG.

No MeSH data available.


Related in: MedlinePlus